Kufunga: Pasi pemamiriro ezvinhu akajairwa emuviri

1. Sei ropa rinoyerera mutsinga dzeropa risingagwambe?

2. Sei tsinga yeropa yakakuvara mushure mekukuvara ichigona kumisa kubuda ropa?

Nemibvunzo iri pamusoro apa, tinotanga kosi yanhasi!

Mumamiriro ezvinhu akajairwa emuviri, ropa rinoyerera mutsinga dzeropa dzevanhu uye harizopfuuri kunze kwetsinga dzeropa zvichikonzera kubuda ropa, uye harizogwambi mutsinga dzeropa zvokonzera thrombosis. Chikonzero chikuru ndechekuti muviri wemunhu une mabasa akaomarara uye akakwana ekubvisa ropa mumuviri uye ekudzivirira kuungana kweropa. Kana basa iri risiri renguva dzose, muviri wemunhu unenge uri panjodzi yekubuda ropa kana thrombosis.

1. Maitiro ekubvisa ropa kubva muropa

Tose tinoziva kuti maitiro ehemostasis mumuviri wemunhu anotanga nekusungana kwetsinga dzeropa, uye zvino kubatana, kuungana uye kuburitswa kwezvinhu zvakasiyana-siyana zveprocoagulant zvemaplatelet kuti zvigadzire soft platelet emboli. Maitiro aya anonzi hemostasis yedanho rimwe chete.

Zvisinei, chinonyanya kukosha ndechekuti inoita kuti system yekubatanidza ropa ishande, inogadzira network ye fibrin, uye pakupedzisira inogadzira thrombus yakagadzikana. Maitiro aya anonzi secondary hemostasis.

2. Maitiro ekubatanidza

Kuvhara ropa inzira iyo zvinhu zvinobatanidza ropa zvinoitwa nenzira yakati kuti zvigadzire thrombin, uye pakupedzisira fibrinogen inoshandurwa kuita fibrin. Maitiro ekufukidza ropa anogona kukamurwa kuita matanho matatu makuru: kuumbwa kweprothrombinase complex, kushanda kwethrombin uye kugadzirwa kwefibrin.

Zvinhu zvinobatanidza ropa (coagulation factors) ndiwo mazita ezvinhu zvine chekuita nekugadzika kweropa muplasma nematishu. Parizvino, kune zvinhu gumi nezviviri zvinobatanidza ropa (coagulation factors) zvakatumidzwa mazita zvichienderana nenhamba dzechiRoma, zvinoti zvinhu zvinobatanidza ropa (coagulation factors) Ⅰ~XⅢ (VI haichaonekwi sezvinhu zvinobatanidza ropa (independent coagulation factors), kunze kweⅣ Iri muchimiro cheionic, uye zvimwe zvese mapuroteni. Kugadzirwa kweⅡ, Ⅶ, Ⅸ, uye Ⅹ kunoda kuti VitK ishande.

Zvichienderana nenzira dzakasiyana dzekutanga uye dzekubatanidza zvinhu zvinobatanidzwa, nzira dzekugadzira prothrombinase complexes dzinogona kukamurwa kuva nzira dze endogenous coagulation uye nzira dze exogenous coagulation.

Nzira yekuomesera ropa (APTT test) inoreva kuti zvinhu zvese zvinobatanidzwa mukuomesera ropa zvinobva muropa, izvo zvinowanzo tangwa nekubata ropa nemuviri wekunze une charge yakaipa (senge girazi, kaolin, collagen, nezvimwewo); Maitiro ekuomesera ropa anotanga nekusangana ne tissue factor anonzi exogenous coagulation pathway (PT test inowanzoshandiswa).

Kana muviri uri muchimiro chechirwere, bhakitiriya endotoxin, complement C5a, immune complexes, tumor necrosis factor, nezvimwewo zvinogona kukurudzira masero eropa endothelial uye monocytes kuti aratidze tissue factor, nokudaro zvichitanga maitiro ekugwamba, zvichikonzera diffuse intravascular coagulation (DIC).

3. Nzira yekudzivirira ropa kuti risaungane

a. Sisitimu yeAntithrombin (AT, HC-Ⅱ)

b. Sisitimu yeMapuroteni C (PC, PS, TM)

c. Mushonga unodzivirira nzira yetishu (TFPI)

Basa: Kuderedza kuumbwa kwefibrin uye kuderedza huwandu hwekushanda kwezvinhu zvakasiyana-siyana zvinobatanidza ropa.

4. Maitiro eFibrinolytic

Kana ropa rikaungana, PLG inoiswa muPL pasi pesimba re t-PA kana u-PA, izvo zvinokurudzira kunyungudika kwe fibrin uye zvinoumba fibrin (proto) degradation products (FDP), uye cross-linked fibrin inoparadzwa sechinhu chaicho. Inonzi D-Dimer. Kuiswa kwe fibrinolytic system kunonyanya kupatsanurwa muzvikamu zviviri: internal activation pathway, external activation pathway uye external activation pathway.

Nzira yekushanda kwemukati: Ndiyo nzira yePL inoumbwa nekutsemuka kwePLG nenzira ye endogenous coagulation, inova ndiyo hwaro hwedzidziso ye secondary fibrinolysis. Nzira yekushanda kwekunze: Ndiyo nzira iyo t-PA inoburitswa kubva mumasero endothelial evascular inotsemura PLG kuti iumbe PL, inova ndiyo hwaro hwedzidziso ye primary fibrinolysis. Nzira yekushanda kwekunze: mishonga ye thrombolytic yakadai se SK, UK ne t-PA inopinda mumuviri wemunhu kubva kunze kwenyika inogona kumutsa PLG kuita PL, inova ndiyo hwaro hwedzidziso yekurapa thrombolytic.

Kutaura zvazviri, nzira dzinoshandiswa mukuita kuti ropa rivhare, ridzivise ropa kuti rivhare, uye kuti rivhare fibrinolysis dzakaoma, uye kune dzakawanda bvunzo dzemurabhoritari dzine chekuita nazvo, asi chatinofanira kutarisisa zvakanyanya i dynamic balance pakati pemasystem, ayo asingagone kuva akasimba zvakanyanya kana kuti asina kusimba zvakanyanya.